Ort hop ope edic Taping, Wrapping,Bracing & Padding Joel W. W. Beam, EdD EdD,, ATC, ATC, LAT LAT Assistant Professor Athleti c Traini Training ng Education Education Prog Program ram Brooks College of Health University of North Florida Jacksonv acksonvilille, le, Flori lorida da
F. A. Davis Company 1915 Arch Street Philadelphia, PA 19103 www.fadavis.com
Copyright © 2006 by F. F. A. Davis Company All rights reserved. This product is protected by copyright. No part of it may be reproduced, stored in a retrieval system, or transmitted in any form or by any means, electronic, mechanical, photocopying, recording, or otherwise, without written permission from the publisher. Printed in the United States of America Last digit indicates print number: 10 9 8 7 6 5 4 3 2 1
Acquisitions Editor: Developmental Editors: Manager of Content Development: Photographers: Design and Illustration Manager: Illustration Coordinator:
Christa A. Fratantoro Caryn Abramowitz, Jennifer A. Pine Deborah Thorp Linden Kinder Cannon IV IV,, Joella Davis Carolyn O’Brien Mike Carcel
As new scientific information becomes available through basic and clinical research, recommended treatments and drug therapies undergo changes. The author(s) and publisher have done everything possible to make this book accurate, up to date, and in accord with accepted standards at the time of publication. The author(s), editors, and publisher are not responsible for errors or omissions or for consequences from application of the book, and make no warranty, expressed or implied, in regard to the contents of t he book. Any practice described in this book should be applied by the reader in accordance with professional standards of care used in regard to the unique circumstances that may apply in each situation. The reader is advised always to check product information (package inserts) for changes and new information regarding dose and contraindications before administering any drug. Caution is especially urged when using new or infrequently ordered drugs. Library of Congress Cataloging-in-Publication Data
Beam, Joel W., 1963 Orthopedic taping, wrapping, bracing & padding / Joel W. Beam. p. ; cm. Includes bibliographical references. ISBN-13: 978-0-8036978-0-8036-1212-9 1212-9 ISBN-10: 0-8036-1212 0-8036-1212-5 -5 1. Sports Sports injuries—T injuries—Treatmen reatment. t. 2. Bandages Bandages and and bandagin bandaging. g. I. Title. Title. II. Title: Title: Orthopedic Orthopedic taping, taping, wrapping wrapping,, bracing bracing and padding padding techniques. [DNLM: [DN LM: 1. Athletic Athletic Injuri Injuries— es—the therap rapy y. 2. Athletic Athletic Injur Injuries ies— — preve pre ventio ntion n & con contro trol. l. 3. Ban Bandag dages. es. 4. Bra Braces. ces. QT 261 B36 B366o 6o 200 2006] 6] RD97.B332 2006 617.1'027—dc22 2006006776
Authorization to photocopy items for internal or personal use, or the internal or personal use of specific clients, is granted by F. A. Davis Company for users registered with the Copyright Clearance Center (CCC) Transactional Reporting Service, provided that the fee of $.10 per copy is paid directly to CCC, 222 Rosewood Drive, Danvers, Danvers, MA 01923. For those organizations that have have been granted a photocopy license by CCC, a separate system of payment has been arranged. The fee code for users of the Transactional Transactional Reporting Service is: 8036/1212/06 0 + $.10.
F. A. Davis Company 1915 Arch Street Philadelphia, PA 19103 www.fadavis.com
Copyright © 2006 by F. F. A. Davis Company All rights reserved. This product is protected by copyright. No part of it may be reproduced, stored in a retrieval system, or transmitted in any form or by any means, electronic, mechanical, photocopying, recording, or otherwise, without written permission from the publisher. Printed in the United States of America Last digit indicates print number: 10 9 8 7 6 5 4 3 2 1
Acquisitions Editor: Developmental Editors: Manager of Content Development: Photographers: Design and Illustration Manager: Illustration Coordinator:
Christa A. Fratantoro Caryn Abramowitz, Jennifer A. Pine Deborah Thorp Linden Kinder Cannon IV IV,, Joella Davis Carolyn O’Brien Mike Carcel
As new scientific information becomes available through basic and clinical research, recommended treatments and drug therapies undergo changes. The author(s) and publisher have done everything possible to make this book accurate, up to date, and in accord with accepted standards at the time of publication. The author(s), editors, and publisher are not responsible for errors or omissions or for consequences from application of the book, and make no warranty, expressed or implied, in regard to the contents of t he book. Any practice described in this book should be applied by the reader in accordance with professional standards of care used in regard to the unique circumstances that may apply in each situation. The reader is advised always to check product information (package inserts) for changes and new information regarding dose and contraindications before administering any drug. Caution is especially urged when using new or infrequently ordered drugs. Library of Congress Cataloging-in-Publication Data
Beam, Joel W., 1963 Orthopedic taping, wrapping, bracing & padding / Joel W. Beam. p. ; cm. Includes bibliographical references. ISBN-13: 978-0-8036978-0-8036-1212-9 1212-9 ISBN-10: 0-8036-1212 0-8036-1212-5 -5 1. Sports Sports injuries—T injuries—Treatmen reatment. t. 2. Bandages Bandages and and bandagin bandaging. g. I. Title. Title. II. Title: Title: Orthopedic Orthopedic taping, taping, wrapping wrapping,, bracing bracing and padding padding techniques. [DNLM: [DN LM: 1. Athletic Athletic Injuri Injuries— es—the therap rapy y. 2. Athletic Athletic Injur Injuries ies— — preve pre ventio ntion n & con contro trol. l. 3. Ban Bandag dages. es. 4. Bra Braces. ces. QT 261 B36 B366o 6o 200 2006] 6] RD97.B332 2006 617.1'027—dc22 2006006776
Authorization to photocopy items for internal or personal use, or the internal or personal use of specific clients, is granted by F. A. Davis Company for users registered with the Copyright Clearance Center (CCC) Transactional Reporting Service, provided that the fee of $.10 per copy is paid directly to CCC, 222 Rosewood Drive, Danvers, Danvers, MA 01923. For those organizations that have have been granted a photocopy license by CCC, a separate system of payment has been arranged. The fee code for users of the Transactional Transactional Reporting Service is: 8036/1212/06 0 + $.10.
Acknowledgments
There are many people that I wish to thank for their time and willingness to assist in this project. At F.A. Davis, Christa Fratantoro, Acquisitions Editor, began by listening to the idea. She has been available to lend guidance and support throughout the entire process. Jennifer Pine provided the direction to bring the ideas from my head, to the inside of a front and back cover. Caryn Abramowitz gave me the necessary tools, wisdom, and confidence to complete each chapter successfully. There are others I would also like to thank. Joella Davis and Kinder Cannon worked tirelessly to produce the photographs. The student models, John Kiddy, Maegan Mathisen, Julie Tribett, Chris Aubrey, Todd Guggisberg, Stephen Melnyk, Aimee Ragasa, Shane Miller, and David Libert performed like veterans during the photo shoot.
Lynne-Marie Young, MEd, ATC, and Bernadette Buckley, PhD, ATC, provided their expertise in the creation of the anatomy illustrations and instructor ancillaries. Melissa Anderson, ATC, provided another set of eyes in the early writing of each chapter. Heather Priest Gilchrist, ATC, and Rachel Daubenmire, ATC, conducted several literature reviews for the research briefs. During the writing of this book, many allied healthcare professionals served as chapter reviewers. I would like to thank each of them for their time and expertise. Their suggestions helped to strengthen the book. A project such as this is not possible without the assistance of numerous manufacturers and others associated with taping, wrapping, bracing, and padding products. I want to thank the following people.
Johnson & Johnson
Kinetic Innovations
Ken Young Inc Jack Weakley
Les Lundberg
3M
Dave Egemo
Douglas Protective Equipment
Doug Douglass Williams Sports Group
BSN-Jobst
Fred Williams
Barbara Himmelein, Ernie Hahn, Russ Kibler, Cindy Massey
Riddell
Active Ankle
Scott Morton Swede-O
Tom Traver Silipos
Andrei Lombardi Sports Health
John Miller, Tom Rokovitz, Amy Bauer Breg
Jeff Regan, Jay Bassett Dj Ortho
Brian Moore, Bob Rojahn Med Spec
Scott Gaylord Ultra Ankle
Rick Peters Aircast
Dennis Mattessich, Bill Bartlett
Kay Johnson Sports Authority
Dan Davis Medco
Don Laux Hartmann Conco
Ernest Nelson Sammons Preston Rolyan Andover Coated Products
Julie Gatto, Ron O’Neil, Christina Costanza Impact Innovative Products
John Matechen University of North Florida
Jim Scholler Mark Power Mike Munch Bob Shepard Mike Weglicki Deborah Miller David Wilson
viii
Acknowledgments
Jacksonville Jackson ville University
Episcopal High School
Doug Frye Tom Leonard
Mark Waybright John Silkey
Florida Atlantic University
Dick’s Sporting Goods
Mike Short
Ed Kish
First Coast Orthotics and Prosthetics
Dr. Richard Salko
Travis Richards Carol Richards
Terri Russ Melissa Acevedo
Bailey Manufacturing Company
Western Michigan University
Brian Kolenich
Michael G. Miller
Jacksonville Jackson ville Orthopaedic Institute
Stone Ridge School of the Sacred Heart
Matt Paulus
Jill Marks
Reviewers
David Berry, PhD, ATC Assistant Professor of Athletic Training Department of Health Promotion and Human Performance Weber State University Ogden, Utah W. David Carr, PhD, ATC/L Clinical Assistant Professor of Athletic Training College of Business Administration The University of Tulsa Tulsa, Oklahoma Tina Davlin, PhD, ATC Assistant Professor and Director, Athletic Training Education Program College of Social Sciences Xavier University Cincinnati, Ohio Jean Fruh, MS, (ABD) ATC Former Assistant Professor and Director of Athletic Training Department of Exercise Science West Virginia Wesleyan College Buckhannon, West Virginia Pete Koehneke, MS, ATC Professor and Director, Athletic Training Education Program Chair, Department of Sports Medicine, Health, and Human Performance Canisius College Buffalo, New York Cynthia McKnight, PhD, ATC Associate Professor of Physical Education Chair, Department of Undergraduate Physical Education & Athletic Training Azusa Pacific University Azusa, California
Matthew Rothbard, MS, ATC Clinical Assistant Professor of Athletic Training Department of Kinesiology Towson University Towson, Maryland Shannon Singletary, PT, ATC, CSCS Supervisor of Sports Medicine Department of Orthopedics/Sports Medicine University of Mississippi Medical Center Jackson, Mississippi Chad Starkey, PhD, ATC Visiting Professor, Athletic Training Program School of Recreation and Sport Sciences Ohio University Athens, Ohio Stacy Walker, PhD, ATC, LAT Assistant Professor of Physical Education School of Physical Education, Sport, & Exercise Science Ball State University Muncie, Indiana Katie Walsh, EdD, ATC Associate Professor and Director, Athletic Training Program The Department of Health Education and Promotion East Carolina University Greenville, North Carolina
Preface
In the Complete Book of Athletic Taping Techniques (Parker Publishing Company, West Nyack, NY, 1972), J.V. Cerney describes taping as “the art and science of utilizing adhesive tape as a productive and functional tool.” Today, this art and science also encompasses wrapping, bracing, and padding. The ability to apply the technique with proper tension and body contouring and placement, while avoiding gaps, wrinkles, and inconsistent layering and pressure is the art . Determining the needs of the healthy individual, the technique to use with a specific injury or condition, the effectiveness of the technique, and the knowledge of the allied health-care professional is the science. Taping, wrapping, bracing, and padding techniques can serve as productive and functional tools when properly applied within a comprehensive therapeutic exercise program. These techniques are designed to compliment range of motion, flexibility, muscular strength and endurance, neuromuscular, cardiorespiratory, and therapeutic modality goals in the prevention, treatment, and rehabilitation of injuries and conditions. Taping, wrapping, bracing, and padding techniques are available in a variety of designs and are applied using many different methods. It is common for allied healthcare professionals to have “their own way” with regards to technique use, construction, or application. These methods are often based on past experiences and anecdotal evidence. In addition, application of the same technique, on two different individuals with similar injuries, often results in different outcomes. The “one-size-fits-all” technique does not currently exist. Therefore, the use of taping, wrapping, bracing, and padding techniques should be based on the intended purpose of the technique, the individual, the injury, the activity, and the available evidence-based data. I wrote this text to provide allied health-care professionals multiple taping, wrapping, bracing, and padding techniques and alternatives. Differences among healthy individuals and their injuries and conditions, the skill and experience levels of allied health-care professionals, material availability, and facility budgets and sizes require a diverse set of strategies in the prevention, treatment, and rehabilitation of healthy individuals. The overall goal of Orthopedic Taping, Wrapping, Bracing, and Padding is to facilitate learning of the cognitive, psychomotor, and affective skills required to effectively tape, wrap, brace, and pad healthy individuals. The book is intended for entry-level undergraduate and graduate athletic training students, practicing athletic trainers, and other allied health-care professionals responsible for technique application. Among students, the text is
designed to first be used in the didactic setting, then taken to the clinical setting for practice and skill development. The material in the text covers the National Athletic Trainers’ Association (NATA) Role Delineation Study and the NATA Education Council Educational Competencies and Proficiencies related to taping, wrapping, bracing, and padding. Among practicing athletic trainers and other allied health-care professionals, the text can serve as a practical resource guide. The text is designed for use in a semester-length course or course component normally taught early in an athletic training education program curriculum. The allinclusive, step-by-step technique focus of the text requires that students possess a general knowledge of anatomy, biomechanics, injury evaluation, treatment, and rehabilitation. This general knowledge can be obtained through either prerequisite or concurrent courses in an education program. Several techniques can be performed during the first day of instruction, while others require advanced knowledge and skill levels obtained through years of clinical experience. Chapter 1 introduces tapes, wraps, braces, and pads and includes types, objectives, and recommendations for application. Chapter 2 provides information on current and long-range needs and structural considerations of the application area. Chapter 3 includes the foot and toes, Chapter 4, the ankle; Chapter 5, the lower leg; Chapter 6, the knee; Chapter 7, the thigh, hip, and pelvis; Chapter 8, the shoulder and upper arm; Chapter 9, the elbow and forearm; Chapter 10, the wrist; Chapter 11, the hand, fingers, and thumb; and Chapter 12, the thorax, abdomen, and spine. These chapters begin with a general review of injuries and conditions that are common to the body region(s). Next, the chapters present step-by-step taping, wrapping, bracing, and padding techniques used in the prevention, treatment, and rehabilitation of these injuries and conditions. Chapter 13 discusses liability issues, standards and testing, and construction and application of NCAA and NFHS mandatory and standard equipment and padding. Several pedagogical features are used throughout the text to enhance the material, to assist the reader in developing critical thinking skills, and to further explain the use and application of the techniques.
Injuries and Conditions Chapters 3 through 12 contain a brief discussion of common injuries and conditions for the particular body region. This feature allows readers to further develop an
xi i
Preface
understanding of the purpose of the technique for each injury and condition.
Photographs and Line Drawings The photography in each chapter plays an integral role in the presentation and learning of the techniques. The photographs are arranged to provide the reader with visual representation of the specific instructions for each technique step. The line drawings illustrate the basic anatomy of each body region to assist the reader in developing an understanding of the purpose and effect of each technique on bone and soft tissue.
Key Words Anatomical structures and positions, injuries and conditions, and important terms are boldfaced to assist readers in recognizing key words.
Helpful Hints Helpful hints, identified by the icon , provide quick tips and other “tricks of the trade” to assist in technique application.
Research Brief Boxes Research brief boxes offer evidence-based information on the techniques.
IF/ THEN Boxes IF/THEN boxes guide the student in choosing the most appropriate technique in a given situation.
Details Boxes Details boxes offer additional information on technique origin, construction, and application.
Critical Thinking Boxes Critical thinking boxes are located throughout each chapter to allow the reader the opportunity to critically synthesize technique use and application. Answers to the questions are provided in the Appendix Solutions section.
Case Study Case studies promote critical thinking and allow the reader the opportunity to select appropriate techniques within an actual injury prevention, treatment, and rehabilitation protocol. Answers to the questions are provided in the Appendix Solutions section.
Wrap-Up The wrap-up summarizes the most important content of each chapter.
Web References Web references provide resources for supplemental information on the prevention, treatment, and rehabilitation of injuries and conditions, on-line journals, surgical procedures, photographs, and other educational materials.
References Each chapter contains a list of cited references to give both the reader and instructor the opportunity to locate additional information.
Glossary Key words from each chapter are located at the end of the book.
Index The index allows for cross-referencing to locate specific techniques and information within the chapters.
Instructor’s CD-ROM The CD-ROM provides multiple choice questions, clinical activities, and real-world situations for each chapter. The questions and activities encompass the NATA Role Delineation Study and NATA Education Council Educational Competencies and Proficiencies associated with taping, wrapping, bracing, and padding techniques. This text does not intend to include every taping, wrapping, bracing, and padding technique that allied health-care professionals currently utilize. I wrote the text to provide athletic training students a comprehensive look into and practicing allied health-care professionals a resource of “the art and science” of taping, wrapping, bracing, and padding. I hope that after each has had the opportunity to read the text, both groups will develop the necessary skills to effectively use the techniques in the prevention, treatment, and rehabilitation of injuries and conditions among healthy individuals. I would appreciate any ideas or suggestions for the improvement of this text in future editions. Please feel free to contact me with your suggestions through F.A. Davis Company, my Publisher, or directly.
Joel W. Beam, EdD, ATC, LAT
Brief Contents
1. Tapes, Wraps, Braces, and Pads
1
2. Facility Design for Taping, Wrapping, Bracing, and Padding 3. Foot and Toes 4. Ankle
35
90
5. Lower Leg 6. Knee
129
153
7. Thigh, Hip, and Pelvis
201
8. Shoulder and Upper Arm 9. Elbow and Forearm 10. Wrist
234
266
310
11. Hand, Fingers, and Thumb 12. Thorax, Abdomen, and Spine
346 382
13. Protect ive Equipment and Padding
411
Appendix A Solutions to Case Studies and Critical
Thinking Questions Glossary Index
446
451
438
28
Contents
INTRODUCTION
Walls
Chapter 1 Tapes, Wraps, Braces, and Pads 1
Ceiling
Electrical
32
Learning Objectives
Plumbing
32
1
Tapes 1 Types 1 Objectives of Taping 2 Recommendations for Tape Application Wraps 7 Types 8 Objectives of Wrapping 8 Recommendations for Wrap Application Braces 11 Types 11 Objectives of Bracing 13 Recommendations for Brace Application Care of Braces 13 Pads 14 Types 14 Resilience 15 Objectives of Padding 15 Recommendations for Pad Application
Lighting 2
8
13
15
Chapter 2 Facility Design for Taping, Wrapping, Bracing, and Padding 28 Tables/Benches Storage 29 Tape 29 Wraps 30 Braces 31 Pads 31 Seating Floors
31 31
28
33 33
Case Study 33 Wrap Up 34 INJURIES AND CONDITIONS OF THE LOWER BODY
Chapter 3 Foot and Toes
Case Study 26 Wrap Up 26
28
32
Ventilation
Sticking Points 24 Tapes 24 Wraps 24 Braces 24 Pads. 26
Learning Objectives
32
Learning Objectives
35
35
Injuries and Conditions Contusions 35 Sprains 35 Strains 35 Fractures 35 Overuse 35 Blisters 36
35
Taping Techniques 37 Circular Arch 37 “X” Arch 38 Loop Arch 40 Weave Arch 42 Low-Dye 44 Plantar Fascia Strap 49 Heel Box 51 Buddy Tape 52 Toe Spica 53 Toe Strips 54 Turf Toe Strap 59 Elastic Material 60 Wrapping Techniques 62 Compression Wrap 62 Bracing Techniques 64 Orthotics 64 Soft Orthotics 64 Semirigid Orthotics 66 Rigid Orthotics 67 Orthotics Fabrication Process
67
xv i
Contents
Off-the-Shelf Night Splints 71 Custom-Made Night Splints 72 Walking Boot 73 Cast Boot 74 Post-Operative Shoe 75
Padding Techniques 75 Longitudinal Arch 75 Donut Pads 77 Heel Pads 79 Metatarsal Bar 80 Tear Drop 81 Oval 82 “J” 83 Toe Wedge 84 Viscoelastic Polymers 85 Outer Toe Box 86
Case Study 88 Wrap Up 88
Chapter 4 Ankle
90
Learning Objectives
90
Injuries and Conditions Sprains 90 Fractures 90 Blisters 90
Learning Objectives
129
129
Injuries and Conditions Contusions 129 Strains 129 Ruptures 129 Overuse 129
129
Taping Techniques 131 Achilles Tendon 131 Dorsal Bridge 134 Peroneal Tendon 136 Spiral Lower Leg 137 Posterior Splint 139 Cast Tape 139 Circular, “X,” Loop, and Weave Arch Low-Dye 140
140
Wrapping Techniques 140 Compression Wrap Technique One 140 Compression Wrap Technique Two 141 Compression Wrap Technique Three 142
90
Taping Techniques 90 Closed Basketweave 91 Elastic 99 Open Basketweave 101 Spartan Slipper 102 Subtalar Sling 104 Spatting 105 Posterior Splint 106 Wrapping Techniques 109 Compression Wraps 109 Soft Cast 111 Cloth Wrap 111 Bracing Techniques 113 Lace-up 113 Semirigid 115 Air/Gel Bladder 117 Wrap 119 Walking Boot 122 Padding Techniques 122 Viscoelastic Polymers 122 Horseshoe Pad 123 Achilles Tendon Strips 124 Donut Pads 125
Case Study 126 Wrap Up 126
Chapter 5 Lower Leg
Bracing Techniques 143 Walking Boot 143 Orthotics 144 Neoprene Sleeve 144 Ankle Braces 145 Padding Techniques 146 Off-the-Shelf 146 Custom-Made 147 Heel Lift 148 Medial Wedge 149 Longitudinal Arch 150 Mandatory Padding 150
Case Study 150 Wrap Up 151
Chapter 6 Knee Learning Objectives
153 153
Injuries and Conditions 153 Contusions 153 Sprains 153 Meniscal tears 153 Medial plica syndrome 153 Anterior knee pain 153 Nerve contusion 155 Fractures 155 Dislocations/subluxations 155 Bursitis 155 Overuse 155 Taping Techniques 155 McConnell Taping 156 Collateral “X” 158
xvii
Contents
Hyperextension 162 Patellar Tendon Strap 165
Custom-Made 231 Mandatory Padding
Wrapping Techniques 169 Compression Wrap Technique One 169 Compression Wrap Technique Two 171 Compression Wrap Technique Three 172
Case Study 232 Wrap Up 232 INJURIES AND CONDITIONS OF THE UPPER BODY, THORAX, ABDOMEN, AND SPINE
Bracing Techniques 173 Prophylactic 173 Rehabilitative 176 Functional 179 Neoprene Sleeve 185 Neoprene Sleeve with Hinged Bars 186 Neoprene Sleeve with Buttress 188 Patellar Tendon Strap 190 Orthotics 191
Chapter 8 Shoulder and Upper Arm Learning Objectives
201
201
Bracing Techniques 249 Slings 249 Off-the-Shelf Shoulder Stabilizers 253 Custom-Made Shoulder Stabilizer 256 Figure-of-Eight Brace 257 Acromioclavicular Joint Brace 259 Neoprene Sleeve 259
Taping Techniques 202 Circular Thigh 202 Hip Pointer Tape 205 Wrapping Techniques 206 Compression Wrap Technique One 206 Compression Wrap Technique Two 207 Compression Wrap Technique Three 208 Quadriceps Strain Wrap 209 Hamstrings Strain Wrap 212 Adductor Strain Wrap 217 Hip Flexor Strain Wrap 219 Gluteal Strain Wrap 220 Hip Pointer Wrap 222 Bracing Techniques 224 Neoprene Sleeve 224 Neoprene Shorts 225 Thigh, Hip, and Pelvis Combination Braces Orthotics 228 Padding Techniques 228 Off-the-Shelf 228
238
Wrapping Techniques 239 Compression Wrap Technique One 239 Compression Wrap Technique Two 240 Compression Wrap Technique Three 242 Circular Upper Arm Wrap 242 Shoulder Spica 243 4 S (Spica, Sling, Swathe, and Support) Wrap Figure-of-Eight Wrap 247 Swathe Wrap 248
201
Injuries and Conditions Contusions 201 Strains 201 Overuse 201
234
Taping Techniques 237 Circular Upper Arm 237 Shoulder Pointer/AC Joint Sprain Tape
Case Study 196 Wrap Up 197
Learning Objectives
234
Injuries and Conditions 234 Contusions 234 Sprains 234 Dislocations/subluxations 234 Fractures 236 Strains 236 Ruptures 237 Overuse 237
Padding Techniques 192 Off-the-Shelf 192 Custom-Made 194 Compression Wrap Pad 195 Heel Lift 196 Donut Pads 196 Mandatory Padding 196
Chapter 7 Thigh, Hip, and Pelvis
231
Padding Techniques 260 Off-the-Shelf 260 Custom-Made 263 Mandatory Padding 264
Case Study 264 Wrap Up 265
Chapter 9 Elbow and Forearm 226
Learning Objectives
266
Injuries and Conditions Contusions 266 Sprains 266
266
266
245
xviii
Contents
Strains 266 Ruptures 266 Dislocations 266 Fractures 267 Bursitis 267 Overuse 267 Abrasions 268
Taping Techniques 268 Hyperextension 269 Collateral “X” 273 Lateral Epicondylitis Strap Figure-of-Eight Elbow Tape Circular Forearm 278 Spiral Forearm 279 Elastic Material 280 Posterior Splint 281
Fan Tape 316 Strip Tape 318 “X” Tape 322 Brace Anchor 326 Wrist Semirigid Cast 326 Posterior Splint 329
Wrapping Techniques 331 Compression Wrap 332 Figure-of-Eight Wrap 333 Bracing Techniques 334 Prophylactic 334 Rehabilitative 336 Functional 338 Custom-Made 339 Slings 340
275 276
Wrapping Techniques 284 Compression Wrap Technique One Compression Wrap Technique Two Compression Wrap Technique Three Compression Wrap Technique Four Compression Wrap Technique Five Circular Elbow Wrap 289 Circular Forearm Wrap 290 Bracing Techniques 292 Rehabilitative 292 Functional 293 Neoprene Sleeve with Hinged Bars Epicondylitis Strap 300 Neoprene Sleeve 303 Slings 304
Padding Techniques 341 Viscoelastic Polymers 341 Donut Pads 342 Custom-Made 342 Cast Padding 342
284 285 286 287 288
Case Study 344 Wrap Up 344
Chapter 11 Hand, Fingers, and Thumb Learning Objectives
Injuries and Conditions 346 Contusions 346 Sprains 346 Dislocations 346 Fractures 346 Tendon ruptures 347 Blisters 347
297
Padding Techniques 304 Off-the-Shelf 304 Custom-Made 306 Compression Wrap Pad 307 Mandatory Padding 307
Taping Techniques 348 Buddy Tape 348 “X” Tape 349 Elastic Material 351 Thumb Spica 354 Thumb Spica Semirigid Cast Figure-of-Eight Tape 364
Case Study 308 Wrap Up 309
Chapter 10 Wrist
310
Learning Objectives 310 Injuries and Conditions 310 Contusions 310 Sprains 310 Triangular fibrocartilage complex (TFCC) Fractures 310 Dislocations 310 Ganglion cysts 310 Overuse 310 Taping Techniques 312 Circular Wrist 312 Figure-of-Eight Tape 314
346
310
Wrapping Techniques 364 Compression Wrap 364 Finger Sleeves 365 Boxer’s Wrap 366 Figure-of-Eight Wrap 367 Bracing Techniques 368 Finger Braces 368 Thumb Braces 372 Padding Techniques 375 Boxer’s Wrap 375 Viscoelastic Polymers 376 Foam Pads 377
362
346
Contents
PROTECTIVE EQUIPMENT
Cast Padding 378 Compression Wrap Pad 379 Mandatory Padding 380
Chapter 13 Protect ive Equipment and Padding 411
Case Study 380 Wrap Up 38 0
Learning Objectives
Standards and Testing 412 Football Helmets 412 Baseball and Softball Batter’s Helmets 413 Baseball and Softball Catcher’s Helmets with Face Guards 413 Lacrosse Helmets with Face Guards 413 Lacrosse Helmet Face Guards 414 Ice Hockey Helmets 414 Ice Hockey Helmets with Face Guards 414 Ice Hockey Helmet Face Guards and Visors 414
382
Injuries and Conditions 382 Contusions 382 Sprains 382 Strains 382 Fractures 384 Costochondral injury 385 Brachial plexus injury 385 Overuse 385 Taping Techniques 386 Elastic Material 386 Contusion/Fracture Tape
386
Wrapping Techniques 387 Compression Wrap Technique One Compression Wrap Technique Two Circular Wrap 390 Swathe Rib Wrap 391 Bracing Techniques 393 Rib Belts 393 Lumbar Sacral Brace 394 Sacroiliac Belts 397 Cervical Collar 398 Slings 403 Padding Techniques 403 Off-the-Shelf 403 Custom-Made 408 Mandatory Padding 408
Case Study 409 Wrap Up 409
411
Liability Issues Surrounding Protective Equipment 411
Chapter 12 Thorax, Abdomen, and Spine 382 Learning Objectives
xi x
387 389
Protective Equipment and Padding Baseball 416 Field Hockey 417 Football 418 Ice Hockey 423 Lacrosse 426 Soccer 427 Softball 427 Wrestling 428 Eye Guards 428 Mouth Guards 430
415
Case Study 435 Wrap Up 436 Appendix A Solutions to Case Studies and Critical Thinking Questions 438 Glossary Index
446
451
CHAPTER
Ankle LEARNI NG OBJECTI VES
1. Discuss common injuries that occur to the ankle. 2. Demonstrate taping, wrapping, bracing, and padding techniques for the 3.
ankle when preventing, treating, and rehabilitating injuries. Explain and demonstrate the application of taping, wrapping, bracing, and padding techniques for the ankle within a therapeutic exercise program.
INJURIES AND CONDITIONS Injury to the ankle can occur during any weight-bearing activity, due to excessive range of motion and repetitive stress. Injury to the bony and ligamentous structures of the ankle can occur from excessive range of motion caused by stepping off a curb while walking and sudden changes of direction during athletic activities. Casual and athletic activities on uneven or poorly maintained surfaces may also contribute to injury. Common injuries to the ankle include: • Sprains • Fractures • Blisters
Sprains Ankle sprains are one of the most common sport-related injuries.3,54 Injuries are caused by excessive, sudden inversion or eversion at the subtalar joint and can be associated with plantar flexion or dorsiflexion at the talocrural joint (Illustration 4-1). Rotation of the foot, either internal or external, can also contribute to injury. An inversion or eversion sprain can result, for instance, when a baseball batter steps on the corner of first base while running straight ahead to beat a throw from the second baseman, causing excessive inversion, eversion, rotation, and/or dorsiflexion. Inversion sprains are more common and can lead to damage of the anterior talofibular, calcaneofibular, and/or posterior talofibular ligaments. Eversion sprains can result in injury to the deltoid liga-
4
ment and are often accompanied by an avulsion fracture of the distal tibia with severe eversion force. Excessive dorsiflexion and external rotation can cause a syndesmosis sprain involving the anterior and posterior tibiofibular ligaments. A syndesmosis sprain can occur, for example, during a fumble recovery in football, as the ankle of a player on the ground is forced into dorsiflexion and external rotation by others diving for the ball.
Fractures Fractures of the distal tibia or fibula can occur in combination with ankle sprains. A severe inversion mechanism can cause an avulsion fracture of the lateral (fibular) malleolus and sometimes an accompanying fracture of the medial (tibial) malleolus, known as a bimalleolar fracture. With eversion sprains, the longer fibular malleolus can be fractured as the talus is forced into the distal end. If the eversion mechanism continues, an avulsion fracture of the tibial malleolus can occur, resulting in a bimalleolar fracture. Mechanisms of injury for distal tibia and fibula fractures include forcible inversion, eversion, dorsiflexion, and internal rotation.
Blisters Athletic, work, and casual footwear can cause irritation of the skin. Application of taping, wrapping, and bracing techniques themselves can cause blisters from shearing forces over the heel, lace, and bony prominence areas such as the medial and lateral malleoli.
Ta p i n g Te c h n i q u e s Several taping techniques reduce inversion and eversion at the subtalar joint, and reduce plantar flexion and dorsiflexion at the talocrural joint, protecting against excessive range of motion. Some techniques are used in preventing sprains to support and limit excessive range of motion, while others provide support to the ankle during a return to activities. Several techniques are used specifically in the acute treatment of sprains and fractures to support or immobilize the ankle. The appropriate technique to use should be based on the intended purpose, the injury, the individual, and the activity.
Taping Techniques Posterior tibiofibular ligament
Tibia
Fibula
Lateral ligaments
Medial malleolus
Talocrural joint
Tibia Anterior talofibular ligament Posterior talofibular ligament Calcaneofibular ligament
91
Deltoid ligaments
Anterior tibiofibular ligament
Subtalar joint
Lateral malleolus
Plantar calcaneonavicular (spring) ligament
A. Lateral view
B. Medial view
Illustration 4-1 Ligaments of the subtalar and talocrural joints.
C l o s e d B a s k e t w ea v e
Figures 4–1, 4–2, 4–3
➧ Purpose: The closed basketweave technique is used both to prevent and treat inversion and eversion
sprains (Fig. 4–1). It provides moderate support to the subtalar and talocrural joints and reduces range of motion. For our purposes, we review a basic closed basketweave first, and then illustrate several variations used to provide additional support. DETAI LS
There may be as many different basketweave techniques as there are health-care professionals applying them, but the majority of the techniques contain some of the procedures described by Gibney15 over 100 years ago. ➧ Materials:
• 11 ⁄ 2 inch or 2 inch non-elastic tape, taping scissors Options: • Pre-tape material or self-adherent wrap, adherent tape spray, thin foam pads, skin lubricant ➧ Position of the individual: Sitting on a taping table or bench with the leg extended off the edge with the
foot in 90 of dorsiflexion.
➧ Preparation: Apply the basketweave technique directly to the skin.
Option: Apply pre-tape material or self-adherent wrap, adherent tape spray, thin foam pads, and skin lubri- cant over the heel and lace areas to provide additional adherence and lessen irritation. Using pre-tape material appears to provide some additional support to the ankle. 40 ➧ Application:
STEP 1: In this example, apply one layer of pre-tape material (Fig. 4–1A).
A Fi gu re 4 -1
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STEP 2: Using 11 ⁄ 2 inch or 2 inch non-elastic tape, apply two anchor strips at a slight angle around the distal lower leg, just inferior to the gastrocnemius belly with moderate roll tension (Fig. 4–1B). An anchor strip can be placed around the midfoot , proximal to the fifth metatarsal head, but this is not required. If this anchor strip is applied, monitor roll tension to prevent constriction as the foot expands upon weight-bearing.
B
Option: Use self-adherent wrap of 2 inch width for these anchors to prevent constriction. STEP 3: When preventing and treating inversion sprains, start the first stirrup on the medial lower leg anchor. Proceed down over the posterior medial malleolus (Fig. 4–1C), across the plantar surface of the foot, and continue up and over the posterior lateral malleolus with moderate roll tension (Fig. 4–1D).
C
D
STEP 4: Finish on the lateral lower leg anchor (Fig. 4–1E).
E
STEP 5: When preventing and treating eversion sprains, apply the stirrups on the lateral lower leg anchor and follow the same steps, finishing on the medial lower leg anchor (Fig. 4–1F).
F Figure 4 -1 continued
Taping Techniques
93
STEP 6: Begin the first horseshoe strip on the medial aspect of the midfoot (Fig. 4–1G), continue around the distal Achilles tendon, across the distal lateral malleolus, and finish on the lateral midfoot with moderate roll tension, proximal to the fifth metatarsal head (Fig. 4–1H).
G
H
STEP 7: Start the second stirrup on the medial lower leg by overlapping the first by 1 ⁄ 2 of the tape width, continue down over the medial malleolus (Fig. 4–1I), across the plantar foot, up and over the lateral malleolus, and anchor on the lateral lower leg (Fig. 4–1J).
I
J
STEP 8: The second horseshoe begins on the medial forefoot and overlaps the first by 1 ⁄ 2 of the tape width (Fig. 4–1K).
K
STEP 9: The third stirrup, beginning on the medial lower leg, overlaps the second and covers the anterior medial and lateral malleoli (Fig. 4–1L).
L Figure 4-1 continued
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STEP 10: Starting on the medial forefoot, apply the third horseshoe, overlapping the second (Fig. 4–1M).
M
STEP 11: Beginning at the third horseshoe, apply closure strips in a proximal direction with moderate roll tension, overlapping each (Fig. 4–1N). Apply the last closure strip over the distal lower leg anchors. Progress proximally, and angle the tape to prevent gaps or wrinkles.
N
STEP 12: Apply 2–3 closure strips around the midfoot in a medial-to-lateral direction with mild to moderate roll tension, remaining proximal to the fifth metatarsal head (Fig. 4–1O).
O Figure 4-1 continued
Heel Locks ➧ Purpose: Use heel locks to provide additional support to the subtalar and talocrural joints and secure the
closed basketweave technique (Fig. 4–2). Based on individual preferences, apply heel locks in either an individual or continuous pattern. Many apply the continuous heel lock to conserve time when applying the basketweave technique. ➧ Materials:
• 11 ⁄ 2 inch or 2 inch non-elastic tape ➧ Position of the individual: Sitting on a taping table or bench with the leg extended off the edge with the
foot in 90°of dorsiflexion. ➧ Preparation: Application of the closed basketweave taping technique.
Taping Techniques
95
Individual Heel Locks ➧ Application:
STEP 1: Using the individual technique, anchor the lateral heel lock with 1 1 ⁄ 2 inch or 2 inch nonelastic tape across the lateral lace area at an angle toward the longitudinal arch (Fig. 4–2A).
A
STEP 2: Continue across the arch, then angle the tape upward and pull across the lateral calcaneus with moderate roll tension (Fig. 4–2B), around the posterior heel, and finish on the lateral lace area (Fig. 4–2C).
B
C
STEP 3: The medial heel lock begins over the medial lace area at an angle toward the lateral malleolus (Fig. 4–2D) and continues across the posterior heel.
D
STEP 4: Then, angle the tape downward and pull across the medial calcaneus with moderate roll tension (Fig. 4–2E), under the heel, and finish on the medial lace area (Fig. 4–2F). Typically, the lateral and medial heel locks are repeated.
E Figure 4-2
F
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Taping Techniques
e l k n Continuous Heel Locks A
➧ Application:
STEP 1: The continuous heel lock technique combines the individual locks and is applied within a figure-of-eight pattern with moderate roll tension. Apply a lateral heel lock as shown in Figure 4-2A–C. STEP 2: Instead of tearing the tape when finished, continue around the distal Achilles tendon (Fig. 4–2G).
G
STEP 3: Angle downward and pull the tape across the medial calcaneus (Fig. 4–2H).
H
STEP 4: Continue across the plantar foot, then up and over the dorsum of the foot toward the superior medial malleolus (Fig. 4–2I), around the posterior lower leg, and finish on the anterior lower leg (Fig. 4–2J). The continuous technique is also often repeated.
I
J
Figure 4-2 continued
Because non-elastic tape does not possess elastic properties, starting with and maintaining the proper angles of the body contours is important . Helpful Hint: Proper angles will be created if the center of the tape width covers the lateral and medial malleoli. Begin the continuous technique by anchoring the center of the tape directly over the lateral malleolus, at an angle toward the longitudinal arch. Center tape placement over the lateral malleolus guides toward a correct lateral heel lock and medial malleolus center placement toward a correct medial heel lock.
Taping Techniques
97
Basketweave Variation One ➧ Purpose: Several variations to the basic closed basketweave technique provide additional support to the
subtalar and talocrural joints and reduce range of motion (Fig. 4-3). These variations are used when individuals are returning to activity or work while treating inversion, eversion, and syndesmosis sprains, and fractures. ➧ Materials:
• 2 inch or 3 inch elastic tape, taping scissors • 2 inch or 3 inch semirigid cast tape, gloves, water, taping scissors ➧ Position of the individual: Sitting on a taping table or bench with the leg extended off the edge with the
foot in 90°of dorsiflexion. ➧ Preparation: Application of the closed basketweave taping technique. ➧ Application:
STEP 1: After applying the closed basketweave, use elastic tape in 2 inch or 3 inch widths for heel locks (Fig. 4–3A). Apply the elastic tape with the individual or continuous technique. Non-elastic tape heel locks can be applied over the elastic tape to provide additional support.
A
STEP 2: If greater support is required, use semirigid cast tape in 2 inch or 3 inch widths for heel locks (Fig. 4–3B). Apply the basketweave technique with heel locks of non-elastic or elastic tape. Anchor the cast tape around the distal lower leg and continue with the continuous heel lock technique with mild to moderate roll tension. Smooth, mold, and shape the cast tape to the ankle. Allow 10–15 minutes for the tape to cure. Additional anchors over the cast tape are not required.
B Figure 4-3
Basketweave Variation Two ➧ Purpose: Another variation is the application of moleskin or thermoplastic material stirrups with the closed
basketweave technique. This variation, using semirigid materials, provides maximal support to the subtalar and talocrural joints, specifically inversion and eversion. ➧ Materials:
• 2 inch or 3 inch moleskin, taping scissors • Paper, felt tip pen, 1 ⁄ 8 inch thermoplastic material, taping scissors, a heating source, an elastic wrap, 2 inch or 3 inch moleskin ➧ Position of the individual: Sitting on a taping table or bench with the leg extended off the edge with the
foot in 90°of dorsiflexion. ➧ Preparation: Application of the closed basketweave taping technique.
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Taping Techniques
Application: STEP 1: Cut moleskin stirrups from 2 inch or 3 inch width material into 25–30 inch length straps (Fig. 4–3C).
C
STEP 2: Fold and cut the middle of the strap at an angle to achieve better fit over the plantar calcaneus (Fig. 4–3D).
D
STEP 3: After applying tape anchors, grasp the ends of the strap and anchor the stirrup on the plantar surface of the calcaneus (Fig. 4–3E).
E
STEP 4: Pull the ends toward the lower leg anchors with equal tension (Fig. 4–3F). The center of the stirrup should be located over the medial and lateral malleoli. The stirrup may also be anchored directly to the skin. Continue applying the closed basketweave and heel lock techniques.
F Figure 4-3 continued
Taping Techniques
STEP 5: Thermoplastic material of 1 ⁄ 8 inch thickness may also be cut into a 3–4 inch width stirrup and fitted to the individual. Design, cut, heat, and mold the material (see Figs. 1–14 and 1–15C–G) over the area from the lateral lower leg anchor, over the lateral malleolus, under the calcaneus, across the medial malleolus, and finish at the medial lower leg anchor. The stirrup can be lined with moleskin (Fig. 4–3G). Apply the closed basketweave and heel lock techniques.
99
G
STEP 6: Place the thermoplastic stirrup on the ankle and apply 2 inch or 3 inch elastic tape heel locks and elastic anchor strips around the distal lower leg with moderate roll tension to attach the stirrup (Fig. 4–3H).
H Figure 4-3 continued
Critical Thinking Question 1 A center on the basketball team is currently in phase III of a rehabilitation program for a second degree eversion ankle sprain. This phase includes position-specific shooting, rebounding, and agility exercises. A closed basketweave technique was applied for support and protection. During the exercises, the center asks whether additional support can be provided. The entire inventory of ankle braces is being used by other members of the team, leaving only taping supplies available for use.
➧
Question: What can be done in this situation?
Elastic
Figure 4–4
➧ Purpose: The elastic technique is an alternative to the closed basketweave and can be applied quickly
(Fig. 4–4). Because this technique offers mild support to the subtalar and talocrural joints, the elastic technique is typically used only when preventing inversion and eversion sprains for noninjured individuals. ➧ Materials:
• 11 ⁄ 2 inch or 2 inch non-elastic tape, 2 inch or 3 inch elastic tape, pre-tape material or self-adherent wrap, thin foam pads, skin lubricant, taping scissors Option: • Adherent tape spray ➧ Position of the individual: Sitting on a taping table or bench with the leg extended off the edge with the
foot in 90°of dorsiflexion. ➧ Preparation: Apply pre-tape material or self-adherent wrap, and thin foam pads and skin lubricant over
the heel and lace areas. Option: Apply adherent tape spray under the pre-tape material or self-adherent wrap for additional adherence.
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Taping Techniques
Application: STEP 1: Begin by placing 11 ⁄ 2 inch or 2 inch non-elastic tape distal lower leg anchors directly to the skin or over pre-tape material or self-adherent wrap.
STEP 2: Apply three consecutive stirrups with 1 1 ⁄ 2 inch or 2 inch non-elastic tape in a medial-to-lateral direction, beginning the first over the posterior medial and lateral malleolus (Fig. 4–4A), overlapping each by 1 ⁄ 2 of the tape width (Fig. 4–4B).
A
B
STEP 3: Using 2 inch or 3 inch elastic tape, anchor on the lateral lace area and apply two continuous heel locks (Fig. 4–4C).
C
STEP 4: From the anterior lower leg, continue to apply the elastic tape in a circular or spiral pattern with moderate roll tension (Fig. 4–4D), overlapping by 1 ⁄ 2 of the tape width, and finish on the lower leg anchor (Fig. 4–4E).
D
E Figure 4-4
Taping Techniques
101
STEP 5: Apply a heel lock with 1 1 ⁄ 2 inch or 2 inch non-elastic tape with moderate roll tension (Fig. 4–4F). Option: Anchor the elastic tape at the distal lower 2 inch or 2 inch non-elastic tape leg with 11 ⁄ . . . . I F / T H E N . . . IF choosing
a taping technique to support the subtalar and talocrural joints of a noninjured individual and time is limited, THEN consider using the elastic technique, which involves fewer steps and can be applied more quickly than the closed basketweave.
Op e n B a s k e t w e a v e
F Figure 4-4 continued
Figure 4–5
➧ Purpose: The open basketweave technique is used in the acute treatment of inversion, eversion, and syn-
desmosis sprains to provide mild support and compression (Fig. 4–5). This technique differs from the closed basketweave in that the anterior lower leg, ankle, and dorsal aspect of the foot are not enclosed by horseshoes or closure strips. The anterior opening is designed to accommodate swelling and effusion, which may be present following a sprain. However, this technique uses the same sequence of stirrups and horseshoes. ➧ Materials:
• 11 ⁄ 2 inch or 2 inch non-elastic tape, adherent tape spray, 3 inch or 4 inch by 5 yard length elastic wrap ➧ Position of the individual: Sitting on a taping table or bench with the leg extended off the edge. If pain
and swelling allow, place the foot in 90 of dorsiflexion.
➧ Preparation: Apply adherent tape spray. ➧ Application:
STEP 1: Apply lower leg anchors, stirrups, and horseshoes directly to the skin with 1 1 ⁄ 2 inch or 2 inch non-elastic tape, as described in Figures 4–1B–M, leaving the anterior lower leg, ankle, and dorsal aspect of the foot open (Fig. 4–5A).
A
STEP 2: Apply closure strips in a proximal direction to the lower leg anchor (Fig. 4–5B) and in a distal direction to the forefoot (Fig. 4–5C), covering the calcaneus and plantar foot . Option: Apply individual heel locks, but do not encircle the ankle.
B
C Figure 4-5
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STEP 3: Anchor the ends of the horseshoes and closure strips with 1 1 ⁄ 2 inch or 2 inch non-elastic tape (Fig. 4–5D).
D
STEP 4: Apply a compression wrap (see Fig. 4-10A) over the open basketweave for further compression (Fig. 4–5E).
E Figure 4-5 continued
Spa r t a n Sl i p per
Figure 4–6
➧ Purpose: The Spartan Slipper technique is used in combination with the closed basketweave in treating
inversion, eversion, and syndesmosis sprains to provide additional support during return to activity and/or work (Fig. 4–6). ➧ Materials:
• 11 ⁄ 2 inch, 2 inch, and 3 inch non-elastic tape Options: • Pre-tape material or self-adherent wrap, adherent tape spray, thin foam pads, skin lubricant ➧ Position of the individual: Sitting on a taping table or bench with the leg extended off the edge with the
foot in 90 of dorsiflexion.
➧ Preparation: Apply directly to the skin.
Option: Apply pre-tape material or self-adherent wrap, adherent tape spray, and thin foam pads and skin lubricant over the heel and lace areas to provide adherence and to lessen irritation. ➧ Application:
STEP 1: Start the technique by placing anchors on the distal lower leg with 11 ⁄ 2 inch or 2 inch non-elastic tape. STEP 2: With 3 inch non-elastic tape, measure and tear a strip to serve as a stirrup. Holding the ends of the stirrup, anchor on the plantar surface of the calcaneus (Fig. 4–6A).
A Figure 4-6
Wrapping Techniques
109
STEP 4: Attach the splint with a 4 inch width by 10 yard length elastic wrap with moderate roll tension in a spiral, distal-to-proximal pattern (Fig. 4–9H). Anchor the wrap with metal clips or loosely applied 1 1 ⁄ 2 inch non-elastic tape. Place the individual on crutches.
H Figure 4-9 continued
Critical Thinking Question 2 Through the outpatient orthopedic clinic, you perform outreach services with an amateur rugby team. A flanker on the team suffers a syndesmosis sprain of his left ankle. Following rehabilitation, a physician allows the flanker to return to practice and competition with appropriate ankle support.
➧
Question: What taping techniques can be used in this situation?
. . . I F / T H E N . . . IF applying
the continuous heel lock taping technique and the correct angles remain problematic, THEN apply pre-tape material in the same pattern at the start of a taping technique for additional practice.
W r a p p i n g Te c h n i q u e s Wrapping techniques are used to provide compression to control swelling and effusion, to provide support, and to reduce range of motion.
C o m p r e s s i o n Wr a p s
Figures 4–10, 4–11
➧ Purpose: The compression wrap technique is used in the acute treatment of inversion, eversion, and
syndesmosis sprains to control mild, moderate, or severe swelling and effusion (Fig. 4–10). ➧ Materials:
• 2 inch, 3 inch, or 4 inch width by 5 yard length elastic wrap, metal clips, 1 1 ⁄ 2 inch non-elastic or 2 inch elastic tape, taping scissors Options: • 1 ⁄ 4 inch or 1 ⁄ 2 inch foam or felt • 2 inch, 3 inch, or 4 inch self-adherent wrap or elastic tape, pre-tape material, thin foam pads ➧ Position of the individual: Sitting on a taping table or bench with the leg extended off the edge and the
foot in pain-free dorsiflexion. ➧ Preparation: Apply the technique directly to the skin. 1 Option: Cut a 1 ⁄ 4 inch or ⁄ 2 inch foam or felt horseshoe pad (see Fig. 4–19A–E). With the use of elastic tape, apply one layer of pre-tape material directly to the skin and use thin foam pads over the heel and lace areas.
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Application: STEP 1: The wrap technique for the ankle is identical to the compression technique for the foot illustrated in Chapter 3, Fig. 3–15 (Fig. 4–10A). Apply the greatest amount of roll tension distally and lessen tension as the wrap continues proximally. 1 Option: Apply the 1 ⁄ 4 inch or ⁄ 2 inch foam or felt horseshoe pad to the medial and/or lateral aspect of the ankle to provide additional com- pression to assist in the control of swelling and effusion (Fig. 4–10B). Two inch, 3 inch, or 4 inch self-adherent wrap or elastic tape may be used if an elastic wrap is not available.
A
. . . I F / T H E N . . . IF the
elastic compression wrap migrates or slides over or off the calcaneus during ambulation and movement of footwear, THEN loosely apply a 11 ⁄ 2 inch non-elastic or 2 inch elastic tape or self-adherent wrap circular strip from the lace area, across the plantar calcaneus, and finish over the lace area to anchor the elastic wrap .
B Figure 4-10
Elastic Sleeve ➧ Purpose: Use an elastic sleeve over the ankle to provide compression when controlling mild, moderate, or
severe swelling and effusion when treating sprains (Fig. 4–11). Unlike elastic wraps, this compression wrap, with proper instruction, can be applied and removed by the individual without assistance. ➧ Materials:
• 3 inch elastic sleeve, taping scissors Options: • 1 ⁄ 4 inch or 1 ⁄ 2 inch foam or felt ➧ Position of the individual: Sitting on a taping table or bench with the leg extended off the edge, or sitting
in a chair. ➧ Preparation: Cut a sleeve from a roll to extend from the proximal toes to the distal lower leg. Cut and use
a double length sleeve to provide additional compression. ➧ Application:
STEP 1: Pull the sleeve onto the foot and ankle directly to the skin in a distal-to-proximal direction (Fig. 4–11). If using a double length sleeve, pull the distal end over the first layer to provide an additional layer. No anchors are required; the sleeve can be cleaned and reused. 1 4 inch or ⁄ 2 inch foam or felt horse- Option: Apply the 1 ⁄ shoe pad to the medial and/or lateral aspect of the ankle to provide additional compression.
Figure 4-11
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STEP 4: Position the horseshoe pad over the medial and/or lateral ankle with the malleoli placed at the bottom of the “U” or in the hole of the pad (Fig. 4–19D).
D STEP 5: Apply the compression or elastic sleeve wrapping techniques over the horseshoe pad to anchor (Fig. 4–19E).
E Figure 4-19 continued
Ac h i l l e s Te n d o n S t r i p s
Figure 4–20
➧ Purpose: The Achilles tendon strip technique reduces shearing forces that may occur when using taping
and bracing techniques (Fig. 4–20). DETAI LS
Applying taping and bracing techniques daily to prevent and treat ankle sprains often causes irritation of the skin. Taping technique closure strips and/or brace straps can cause irritation, especially over the Achilles tendon. Abnormal body contours, such as malalignment of the Achilles tendon, may also lead to irritation. ➧ Materials:
• 1 ⁄ 4 inch or 1 ⁄ 2 inch foam, taping scissors ➧ Position of the individual: Sitting on a taping table or bench with the leg extended off the edge with the
foot in 90 of dorsiflexion.
➧ Preparation: Apply the strips directly to the skin. ➧ Application:
STEP 1: Cut two strips approximately 1–1 1 ⁄ 2 inches in width and 4–6 inches in length, from 1 ⁄ 4 inch or 1 ⁄ 2 inch foam. STEP 2: Position the strips on each side of the Achilles tendon with the distal end just superior to the tendon’s insertion on the calcaneus (Fig. 4–20A).
A Figure 4-20
Padding Techniques
125
STEP 3: When applying a taping technique, cover the strips with pre-tape material or selfadherent wrap and continue with the technique (Fig. 4–20B).
B
STEP 4: With braces, position the strips and anchor them with a circular pattern of 2 inch selfadherent wrap or pre-tape material and 2 inch elastic tape with mild roll tension (Fig. 4–20C). Continue by applying a sock, then the brace.
C Figure 4-20 continued
Do n u t Pa d s ➧ Purpose: Donut pads can also be used to reduce shearing forces on the ankle (see Fig. 3–27).
• Cut pads from 1 ⁄ 8 inch or 1 ⁄ 4 inch foam or felt and place them over the medial and/or lateral malleoli. • The pad may be used under taping, wrapping, and bracing techniques. • With taping techniques, attach the pad directly to the skin with adhesive gauze material (see Fig. 3–13) prior to tape application or with pre-tape material (see Fig. 4–1A) during the taping technique. • When applying wrapping techniques, anchor the pad within the technique. • With bracing techniques, attach the pad with adhesive gauze material (see Fig. 3–13) or pre-tape material and 2 inch elastic tape, with the heel lock technique (see Fig. 4–2).
Critical Thinking Question 6 After several weeks of treatment and rehabilitation for an ankle sprain/fracture, a salesperson for an automobile dealership returns to work. The physician recommends that all work activities be performed with a semirigid brace on the ankle. Soon, the brace begins to cause skin irritation over the lateral malleolus.
➧
Question: How can you manage this situation?
. . . I F / T H E N . . . IF using
viscoelastic polymer, foam, or felt materials for padding, in combination with an ankle taping, wrapping, or bracing technique, THEN choose the appropriate thickness of the material; the material should reduce shear forces, but not affect the fit and suppor t provided by the technique, which can occur with an excessively thick pad.
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Chapter 4: Ankle
Ca s e S t u d y Meghan Stewart is a two-sport athlete at Brown College, participating on the volleyball team in the fall and the softball team in the spring. During the first competitive volleyball match of the season, Meghan jumped to block a spike at the net. When she landed, her right foot struck a teammate's shoe, causing a moderate inversion and plantar flexion force. Meghan has no history of ankle injury and was not wearing a prophylactic tape, brace, or wrap technique. Meghan was taken to the Athletic Training Room for evaluation by Lauren Bargar, ATC, and by the team physician. Following an evaluation and subsequent radiographs, Meghan was diagnosed by the physician with a moderate right ankle inversion sprain. The team physician ordered Meghan to be immobilized at 90 of ankle dorsiflexion, non–weight-bearing, for 5 to 10 days. During this time, Meghan could receive treatment to her ankle. What taping, wrapping, bracing, and/or padding techniques would help to immobilize, support, and control swelling and effusion in Meghan's right ankle? Meghan is progressing well within the therapeutic exercise program Lauren and the team physician have designed. Meghan is now ready to begin sport-specific drills during volleyball practice. The team physician requests that Meghan's ankle be supported during these drills and for the remainder of the season. What are the appropriate taping, wrapping, and/or bracing techniques that you could use to provide support to the ankle upon a return to activity? Meghan finishes the volleyball season without further injury and is ready to begin practice with the softball team. Meghan asks Lauren if she can continue with some type of ankle support during softball practices. Lauren agrees and continues applying the technique used for volleyball practices and competitions. During softball practice, a base running drill requires Meghan to sprint from home plate to second base. As she steps on first base, her right ankle is forced into dorsiflexion, and she experiences pain. Meghan finishes practice and returns to the Athletic Training Room to talk to Lauren about a different technique for support. Which techniques can you use to provide support and limit dorsiflexion to allow Meghan to participate pain-free?
WRAP UP • Ankle sprains are caused by excessive range of motion and are common in athletic activities. Fractures can occur in combination with sprains. • Blisters can result from repetitive shearing forces caused by footwear and the application of taping, wrapping, and bracing techniques. • The closed basketweave, heel lock, elastic, open basketweave, Spartan Slipper, subtalar sling, and spatting techniques provide support and reduce range of motion of the subtalar and talocrural joints. • Cast tape and off-the-shelf fiberglass splints provide immobilization in treating sprains and fractures. • Elastic wraps, tapes, and sleeves, as well as soft cast compression techniques, control swelling and effusion following injury.
• Cloth wraps provide mild support when preventing ankle sprains. • Lace-up, semirigid, air/ gel bladder, and wrap braces provide support and compression, and limit range of motion when preventing and treating ankle sprains and fractures. • Walking boots and posterior splints can be used to provide support and i mmobilization. • Viscoelastic polymers, donut, and Achilles tendon strip pad techniques reduce shearing forces. • The horseshoe pad technique provides compression to reduce swelling and effusion.
■ WEB REFERENCES
■ REFERENCES
American Academy of Orthopaedic Surgeons http:// www.aaos.org • This Web site allows you to search for information about the mechanism, treatment, and rehabilit ation of ankle injuries. The American College of Foot & Ankle Orthopedics & Medicine http:// www.acfaom.org • This site provides general information on common injuries and conditions.
1. Alt, W, Lohrer, H, and Gollhofer, A: Functional properties of adhesive ankle taping: Neuromuscular and mechanical effects before and after exercise. Foot Ankle Int 20:23 8–245, 199 9. 2. Bahr, R, Karlsen, R, Lian, O, and Ovrebo, RV: Incidence and mechanisms of acute ankle inversion injuries in volleyball: A retrospective cohort study. Am J Sports Med 22: 595 –600, 199 4. 3. Barker, HB, Beynnon, BD, and Renström, AFH: Ankle injury risk factors in sports. Sports Med 23:69 –74, 1997 .
Chapter 4: Ankle 4. Bocchinfuso, C, Sitler, MR, and Kimura, IF: Effects of two semirigid prophylactic ankle stabilizers on speed, agility, and vertical jump. J Sport Rehabil 3:12 5–134, 1994 . 5. Burks, RT, Bean, BG, Marcus, R, and Barker, HB: Analysis of athletic performance with prophylactic ankle devices. Am J Sports Med 19:10 4–106, 1991. 6. Cordova, ML, Cardona, CV, Ingersoll, CD, and Sandrey, MA: Long-term ankle brace use does not affect peroneus longus muscle latency during sudden inversion in normal subjects. J Athl Train 35:407–411, 2000. 7. Cordova, ML, and Ingersoll, CD: The effect of chronic ankle brace use on peroneus longus stretch reflex amplitude [abstract]. Med Sci Sports Exerc 32(suppl):274 , 200 0. 8. Cordova, ML, Ingersoll, CD, and LeBlanc, MJ: Influence of ankle support on joint range of motion before and after exercise: A meta-analysis. J Orthop Sports Phys Ther 30:170–182, 2000. 9. Cordova, ML, Ingersoll, CD, and Palmieri, RM: Efficacy of prophylactic ankle support: An experimental perspective. J Athl Train 37 :446–457, 2002. 10. Feuerbach, JW, and Grabiner, MD: Effect of t he Aircast on unilateral postural control: Amplitude and frequency variables. J Orthop Sports Phys Ther 7:149 –154, 199 3. 11. Feuerbach, JW, Grabiner, MD, Koh, TJ, and Weiker, GG: Effect of an ankle orthosis and ankle ligament anesthesia on ankle joint proprioception. Am J Sports Med 22:22 3–229, 1994. 12. Freeman, MA, Dean, MR, and Hanham, IW: The etiology and prevention of functional instability of the foot. J Bone Joint Surg Br 47:678–685, 1965. 13. Garrick, JG: The frequency of injury, mechanism of injury, and epidemiology of ankle sprains. Am J Sports Med 5:241–242, 1977. 14. Garrick, JG, and Requa, RK: Role of external support in the prevention of ankle sprains. Med Sci Sports 5:200–203, 1973. 15. Gibney, VP: Sprained ankle: A treatment that involves no loss of time, requires no crutches, and is not attended with an ultimate impairment of function. NY Med J 61:19 3–197, 1985 . 16. Goldie, PA, Evans, OM, and Bach, TM: Postural control following inversion injuries of the ankle. Arch Phys Med Rehabil 75:969–975, 1994. 17. Greene, TA, and Hillman, SK: Comparison of support provided by a semirigid ort hosis and adhesive ankle taping before, during, and after exercise. Am J Sports Med 18:498–506, 1990. 18. Greene, TA, and Wight, CR: A comparative support evaluation of three ankle orthoses before, during, and after exercise. J Orthop Sports Phys Ther 11: 453 –466, 199 0. 19. Gross, MT, Ballard, CL, Mears, HG, and Watkins, EJ: Comparison of Donjoy Ankle Ligament Protector and Aircast Sport-Stirrup orthoses in restricting foot and ankle motion before and after exercise. J Orthop Sports Phys Ther 16:60–67, 1992. 20. Gross, MT, Batten, AM, Lamm, AL, Lorren, JL, Stevens, JJ, Davis, JM, and Wilkerson, GB: Comparison of DonJoy ankle ligament protector and subtalar sling ankle taping in restricting foot and ankle motion before and after exercise. J Orthop Sports Phys Ther 19:3 3–41, 1994 . 21. Gross, MT, Bradshaw, MK, Ventry, LC, and Weller, KH: Comparison of support provided by ankle taping and semirigid orthosis. J Orthop Sports Phys Ther 9:33–39 , 198 7. 22. Gross, MT, Clemence, LM, Cox, BD, McMillan, HP , Meadows. AF, Piland, CS, and Powers, WS: Effect of ankle ort hoses on functional performance for individuals with recurrent lat eral ankle sprains. J Orthop Sports Phys Ther 25:24 5–252 , 199 7. 23. Gross, MT, Everts, JR, Roberson, SE, Roskin, DS, and Young, KD: Effect of DonJoy Ankle Ligament Protector and Aircast Sport-Stirrup orthoses on functional performance. J Orthop Sports Phys Ther 19:150 –156, 1994 . 24. Gross, MT, Lapp, AK, and Davis, JM: Comparison of Swede-O Universal Ankle Support and Aircast Sport-Stirrup orthoses and ankle tape in restricting eversion-inversion before and after exercise. J Orthop Sports Phys Ther 13:1 1–19, 199 1. 25. Heit, EJ, Lephart, SM, and Rozzi, SL: The effect of ankle bracing and taping on joint position sense in the stable ankle. J Sport Rehabil 5:206–213, 1996.
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26. Irvin, R, Iverson, D, and Roy, S: Sports Medicine Prevention, Evaluation, Management, and Rehabilitation, ed 2. Allyn & Bacon, Boston, 1998, pp 59–61. 27. Isakov, E, Mizrahi, J, and Solzi, P: Response of the peroneal muscles to sudden inversion of the ankle during standing. Int J Sport Biomech 2:100–109, 1986 . 28. Jerosch, J, Hoffstetter, I, Bork, H, and Bischof, M: The influence of orthoses on the proprioception of the ankle joint. Knee Surg Sports Traumatol Arthrosc 3:3 9–46, 199 5. 29. Jerosch, J, Thorwesten, L, Bork, H, and Bischof, M: Is prophylactic bracing of the ankle cost effective. Orthopedics 19:405–414, 1996. 30. Jerosch, J, Thorwesten, L, Frebel, T, and Linnenbecker, S: Influence of external stabilizing devices of the ankle on sportspecific capabilit ies. Knee Surg Sports Traumatol Arthrosc 5:50–57, 1997. 31. Juvenal, JP: The effects of ankle taping on vertical jumping ability. Athl Train J Natl Athl Train Assoc 7:1 46–14 9, 197 2. 32. Karlsson, J, and Andreasson, GO: The effect of ankle support in chronic lateral ankle joint instability: An electromyographic study. Am J Sports Med 20:2 57–261, 1992. 33. Konradsen, L, Voigt, M, and Hojsgaard, C: Ankle inversion injuries: The role of the dynamic defense mechanism. Am J Sports Med 25:54–58, 1997. 34. Laughman, RK, Carr, TA, Chao, EY, Youdas, JW, and Sim, FH: Three-dimensional kinematics of the taped ankle before and after exercise. Am J Sports Med 8:42 5–431 , 198 0. 35. Locke, A, Sitler, MR, Aland, C, and Kimura, I: Long-term use of a softshell prophylactic ankle stabili zer on speed, agility, and vertical jump performance. J Sport Rehabil 6:235–245, 1997. 36. Löfvenburg, R, and Kärrholm, J: The influence of an ankle orthosis on the talar and calcaneal motions in chronic lateral instability of the ankle: A stereophotogrammetric analysis. Am J Sports Med 21:224–230, 1993. 37. Lohrer, H, Alt, W, and Golhofer, A: Neuromuscular properties and functional aspects of taped ankles. Am J Sports Med 27:69–75, 1999. 38. MacKean, LC, Bell, G, and Burnham, RS: Prophylactic ankle bracing vs. taping: Effects on functional performance in female basketball players. J Orthop Sports Phys Ther 22:77–81, 1995. 39. Macpherson, K, Sitle, MR, Kimura, I, and Horodyski, M: Effects of a semi-rigid and softshell prophylactic ankle stabilizer on selected performance tests among high school football players. J Orthop Sports Phys Ther 21:1 47–15 2, 199 5. 40. Malina, RM, Plagenz, LB, and Rarick, GL: Effect of exercise upon the measurable supporting strength of cloth and tape wraps. Res Q 34:15 8–165, 1963 . 41. Manfroy, PP, Ashton-Miller, JA, and Wojtys, EM: The effect of exercise, prewrap, and athletic tape on the maximal active and passive ankle resistance to ankle-inversion. Am J Sports Med 25:156–163, 1997. 42. Martin, N, and Harter, RA: Comparison of inversion restraint provided by ankle prophylactic devices before and after exercise. J Athl Train 28:324–329, 1993 . 43. Mayhew, JL: Effects of ankle taping on motor performance. Athl Train J Natl Athl Train Assoc 7:1 0–11, 197 2. 44. McCaw, ST, and Cerullo, JF: Prophylactic ankle stabilizers affect ankle joint kinematics during drop landings. Med Sci Sports Exerc 31:70 2–707, 1999. 45. McIntyre, DR, Smith, MA, and Denniston, NL: The effectiveness of strapping techniques during prolonged dynamic exercises. J Athl Train 18:52–55, 1983 . 46. Metcalfe, RC, Schlabach, GA, Looney, MA, and Renehan, EJ: A comparison of moleskin tape, linen tape, and lace-up brace on joint res trict ion and movement performance. J Athl Train 32:136–140, 1997. 47. Myburgh, KH, Vaughan, CL, and Isaacs, SK: The effects of ankle guards and taping on joint motion before, during, and after a squash match. Am J Sports Med 12:44 1–446, 1984 . 48. Nishikawa, T, and Grabiner, MD: Peroneal motoneuron excitabilit y increases i mmediately following application of a semirigid ankle brace. J Orthop Sports Phys Ther 29:168–176, 1999.
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e l k 49. Palmieri, RP, Ingersoll, CD, Cordova, ML, and Kinzey, SJ: n Prolonged ankle brace application does not affect the spec A tral properties of postural sway [abstract]. Med Sci Sports Exerc 33(suppl):153, 2001 . 50. Paris, DL: The effects of the Swede-O, New Cross, and McDavid ankle braces and adhesive taping on speed, balance, agility, and vertical jump. J Athl Train 27:2 53–25 6, 1992. 51. Pederson, TS, Ricard, MD, Merrill, G, Schulthies, SS, and Allsen, PE: The effects of spatt ing and ankle taping on inversion before and after exercise. J Athl Train 32:2 9–33, 199 7. 52. Pienkowski, D, McMorrow, M, Shapiro, R, Caborn, DN, and Stayton, J: The effect of ankle stabilizers on athletic performance: A randomized prospective study. Am J Sports Med 23:757–762, 1995. 53. Rarick, GL, Bigley, G, Karst, R, and Malina, RM: The measurable support of the ankle joint by conventional methods of taping. J Bone Joint Surg Am 44:1 183 –1190 , 196 2. 54. Reeves, DA, and Emel TJ, http:// www.emedicine.com/ sports/ topic143.htm, Ankle taping and bracing, 2001. 55. Rovere, GD, Clarke, TJ, Yates, CS, and Burley, K: Retrospective comparison of taping and ankle stabilizers in preventing ankle injuries. Am J Sports Med 16:228–233, 1988. 56. Simoneau, GG, Degner, RM, Kramper, CA, and Kittelson, KH: Changes in ankle joint proprioception resulting from strips of athletic tape applied over the skin. J Athl Train 32:14 1–147, 1997.
57. Sitler, MR, and Horodyski, M: Effectiveness of prophylactic ankle stabilizers for prevention of ankle injuries. Sports Med 20:53–57, 1995. 58. Surve, I, Schwellnus, MP , Noakes, T, and Lombard, C: A fivefold reduction in the incidence of recurrent ankle sprains in soccer players using the Sport-Stirrup orthosis. Am J Sports Med 22:601–606, 1994. 59. Tropp, H, Askling, C, and Gillquist, J: Prevention of ankle sprains. Am J Sports Med 13:259–262, 1985 . 60. Vaes, P, De Boeck, H, Handlberg, F, and Opdecam, P: Comparative radiological study of the influence of ankle joint strapping and taping on ankle stability. J Orthop Sports Phys Ther 7:110–114, 1985 . 61. Vaes, PH, Duquet, W, Handelberg, F, Casteleyn, PP, Tiggelen, RV, and Opdecam, P: Influence of ankle strapping, taping, and nine braces: A stress roentgenologic comparison. J Sport Rehabil 7:157–171, 1998. 62. Verbrugge, JD: The effects of semirigid Air-Stirrup bracing vs. adhesive ankle taping on motor performance. J Orthop Sports Phys Ther 23:320–325, 1996. 63. Wilkerson, GB: Biomechanical and neuromuscular effects of ankle taping and bracing. J Athleti c Training 37:436–445 , 200 2. 64. Wilkerson, GB: Comparative biomechanical effects of the standard method of ankle taping and a taping method designed to enhance subtalar stability. Am J Sports Med 19:588–595, 1991.
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Taping Techniques
M C C o n n e l l Ta p i n g
Figure 6–1
➧ Purpose: The McConnell taping technique 67,69 is used to treat PFSS and to provide relief of pain and cor-
rect patellofemoral malalignment (Fig. 6–1). Use the technique within a therapeutic exercise program that consists of stretching tight lateral structures, retraining and strengthening the vastus medialis oblique muscle, mobilizing the patella, and correcting structural foot abnormalities. 33,68,69 • Rigid non-elastic tape in 1 1 ⁄ 2 inch width is placed over adhesive gauze material and is used to correct patellar malalignment. Many manufacturers offer the tape; it is also available in kits containing the adhesive gauze material. • Design the application of the technique specifically for the individual with regard to the sequence of tape strips and roll tension, or how tightly the tape is applied. • Begin the sequence of strips with correction of the most excessive malalignment component. Use additional strips to correct other components if necessary. • After applying each strip, re-evaluate the painful activity. There should be an immediate decrease in pain. If the pain does not lessen or if it worsens, reapply the strips or re-evaluate patellar orientation. ➧ Materials:
• 11 ⁄ 2 inch rigid non-elastic tape, 2 inch adhesive gauze material, taping scissors ➧ Position of the individual: Sitting on a taping table or bench with the knee in extension and the quadri-
ceps relaxed. ➧ Preparation: Perform a static and dynamic evaluation of the individual to determine patellar glide, rotation,
tilt, and anteroposterior orientation components. Shaving may be necessary for effective application. ➧ Application:
STEP 1: Apply two strips of 2 inch adhesive gauze material directly to the skin over the patella, extending from the lateral femoral condyle to the posterior aspect of the medial femoral condyle to serve as a base (Fig. 6–1A).
AA
STEP 2: To correct the glide component (typically a positive lateral glide), anchor a strip of rigid non-elastic tape on the lateral border of the patella (Fig. 6–1B). Pull the strip in a medial direction and push the soft tissue on the medial aspect of the knee toward the patella, and anchor on the adhesive gauze material over the medial femoral condyle (Fig. 6–1C).
BB
Figure 6-1
CC
Taping Techniques
STEP 3: To correct the rotation component (commonly positive external rotation of the inferior pole), place a strip of rigid tape on the middle of the inferior pole of the patella at an angle (Fig. 6–1D). Pull the strip upward and medially, and anchor on the medial aspect of the knee (Fig. 6–1E). The superior pole of the patella should rotate laterally.
DD
EE
FF
G G
STEP 4: To correct the tilt component (often a positive lateral tilt), anchor a strip of rigid tape on the middle of the patella (Fig. 6–1F). Pull the strip medially, push the medial knee soft tissue toward the patella, and anchor on the medial femoral condyle (Fig. 6–1G).
STEP 5: To correct the anteroposterior component (commonly a positive inferior tilt), place a strip of rigid tape across the upper half of the patella and anchor the strip on the lateral and medial femoral condyles (Fig. 6–1H) .
HH
Figure 6-1
continued
Helpful Hint: A positive anteroposterior inferior tilt may require correction first in the taping sequence to lift the inferior pole of the patella away from the infrapatellar fat pad to prevent irritation and pain. 33
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R ES E A R C H B R I E F The McConnell taping technique is used by many health-care professionals when treating PFSS. While positive outcomes have been demonstrated when the technique has been used in the clinical setting, many questions remain unanswered. Investigators examining the effectiveness of the technique when treating PFSS have demonstrated inconclusive findings. The influence of patellar taping on pain levels has been well documented in the literature. Researchers 18,26,27,29,31,32,34,46,50,51,83,109 have found an immediate decrease in pain levels during a stimulating task following tape application. However, explanations for the reduction in pain remain unclear. Some researchers have questioned whether the reduction is a result of the actual technique, a placebo effect, a structural correction in patellar alignment, or a neuroinhibitory mechanism.18,31,45,46,53,55,60 Research focusing on the effect of taping on patellar alignment with radiographic studies has produced conflicting findings. Examining subjects with PFSS, positional patellar changes were demonstrated following medial taping. 90,98 In healthy subjects, medial taping also resulted in positional changes, but lessened following 15 minutes of intense exercise. 60 Other researchers have found no changes in patellar positioning among subjects with PFSS following tape application.18,45,108,109 Studies examining the influence of patellar taping on quadriceps muscle function have demonstrated
Co l l a t e r a l “ X”
inconsistent findings. Among subjects with PFSS, patellar taping was found to increase isokinetic concentric29,49 and eccentric 29 torque of the quadriceps compared with placebo tape and brace. With vertical jump and lateral step-up movements, tape was shown to increase knee extensor moment and power compared with placebo tape, brace, and no tape among subjects with PFSS. 38 Activation of the vastus medialis oblique was shown to increase during a maximal quadriceps contraction following application of patellar tape. 69 Other studies have revealed no change following taping in vastus medialis oblique and vastus lateralis activity during isotonic and isometric quadriceps contractions. 26,51 The timing of vastus medialis oblique activity during ascent and descent of stairs has been shown to occur earlier with patellar taping. 46 During a 4-week therapeutic exercise program, patellar taping was found to have little benefit over a standard rehabilitation program in regard to isokinetic strength and vastus medialis oblique and vastus lateralis activation. 58 The effect and role of patellar taping in the treatment of PFSS appear to be unclear. 17,33,58 The research suggests that using taping achieves immediate reductions in levels of pain during activity.17,33,45 However, the effect of taping on other possible causes of PFSS has yet to be answered and warrants further investigation. 17,18,33,46,53,60
Figure 6–2
➧ Purpose: The collateral “X” technique is used in the treatment of medial and lateral collateral ligament
sprains to provide mild to moderate support and protection against valgus and varus forces at the knee (Fig. 6–2). ➧ Materials:
• Pre-tape material, 3 inch heavyweight elastic tape, adherent tape spray, taping scissors Option: • 6 inch width by 5 yard length elastic wrap ➧ Position of the individual: Standing on a taping table or bench with the majority of the weight on the
noninvolved leg and the involved knee placed in slight flexion. Maintain this position by placing a 1 1 ⁄ 2 inch lift under the heel . Helpful Hint: You can construct a quick and inexpensive heel lift from paper or plastic tape cores of 1 1 ⁄ 2 inch or 2 inch width tape. Place five to seven of these cores together and apply non-elastic or elastic tape around them, completely covering all sides. You can store the lift in a taping table or bench between uses.
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Bracing Techniques
N eo p r e n e S l eev e w i t h H i n g e d Ba r s
Figure 6–17
➧ Purpose: Neoprene sleeves with hinged bars provide compression and mild to moderate support to the
knee following injury (Fig. 6–17). These braces are commonly used when treating mild and moderate MCL and LCL and mild ACL and PCL sprains to control valgus, varus, and rotary stresses. DETAI LS
Use the sleeves during rehabilitative, athletic, work, and casual activities. The nonpliable materials, commonly the hinges, must be padded to meet NCAA75 and NFHS76 rules. ➧ Design:
• The universal fit sleeves are available off-the-shelf in predetermined sizes corresponding to thigh and knee circumference measurements. • The sleeves are manufactured in standard and short length designs to accommodate individual height differences. • Most designs consist of a one-piece neoprene sleeve with medial and lateral hinged aluminum bars, and two nylon strap closures. • Some designs use a contoured sleeve that wraps around the knee to accommodate hard-to-fit leg shapes. These designs are anchored on the anterior thigh and lower leg with Velcro. • The sleeves are constructed with an open patella front; some sleeves also have an open popliteal space cut-out. • Most designs have a polycentric hinge that allows for range of motion control. A hyperextension block is also available. • Some designs have a small adjustable hinge similar to the rehabilitative brace. • Most designs are constructed with proximal and distal pockets or pouches that anchor the medial and lateral bars to the sleeve. Outer nylon straps provide further support to the bars. • To provide additional support, some designs have condyle pads located under the hinges at the joint line, attached to the sleeve with Velcro. ➧ Position of the individual: Sitting on a taping table or bench with the leg extended off the edge, or in a
chair, with the knee in approximately 45 of flexion.
➧ Preparation: Apply neoprene sleeves with hinged bars directly to the skin; no anchors are required. Set
the brace range of motion at the desired settings of flexion and extension. Follow the instructions of the manufacturer when applying the sleeves. The following application guidelines pertain to most sleeves. ➧ Application:
STEP 1: Begin by loosening the thigh and lower leg straps. STEP 2: Grasp the loops above the proximal ends of the bars and pull the brace in a proximal direction over the knee. Center the hinges over the joint line with the cut-out positioned over the patella (Fig. 6–17A).
A A Figure 6-17
Bracing Techniques
187
STEP 3: With the contoured or wrap around design, position the brace on the posterior thigh and lower leg. Wrap the sleeve around and anchor on the anterior thigh and lower leg with Velcro closures (Fig. 6–17B). Center the hinges over the joint line.
BB
STEP 4: The application of straps will depend on the specific sleeve design. Apply most by pulling the straps tight and anchoring with Velcro (Fig. 6–17C) .
C C Figure 6-17
continued
Helpful Hint: Elastic wrap, clothing fibers, and debris from playing surfaces often adhere to the male ends of the Velcro closures and lessen adherence. To increase adherence, clean the male ends of fibers and debris with small, pointed scissors or tweezers.
. . . I F / T H E N . . . IF support
and protection are needed following a MCL sprain and taping is not an option, THEN consider using a prophylactic or neoprene sleeve with hinged bars brace design, which will protect against valgus forces and further injury.
Critical Thinking Question 4 A forward on an intercollegiate ice hockey team suffers a first degree LCL sprain of the right knee. Following a short period of rehabilitation, the athlete is allowed to return to activity. The team physician requests that the knee be supported and protected from further injury for a period of 2 weeks during all practices and competitions. During this 2-week period, 10 practices and 2 competitions will occur.
➧
Question: Which taping or bracing technique can you use? Which technique would be cost effective?
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Neo p r en e S l eev e w i t h Bu t t r es s
Figures 6–18, 6–19
➧ Purpose: Neoprene sleeves with buttresses provide compression, reduce friction and stress, provide mild
to moderate support, and correct structural abnormalities when treating PFSS, chondromalacia, patellar dislocations and subluxations, patellar tendinitis, and OSD. A variety of buttress sleeve designs are available to treat these injuries and conditions. DETAI LS
Fixed and adjustable sleeves can be used with athletic, work, and casual activities.
• These sleeves may be purchased off-the-shelf in right and left styles, with predetermined sizes corresponding to thigh and knee circumference measurements. • The designs consist of a neoprene sleeve with a fixed or adjustable buttress with various straps.
Fixed Butt ress ➧ Design:
• Fixed buttresses are incorporated into the brace and do not allow for adjustments during application or activity (Fig. 6–18). • Fixed buttress sleeves are constructed with an open patella front, surrounded by a felt, silicone, rubber, foam, or pneumatic buttress in the shape of an uppercase “C,” “H,” “J,” or “U,” or circular pattern. • The “C”- and “J”-shaped buttresses are designed to limit lateral movement of the patella. • The “H”-shaped buttress is designed to limit inferior and superior patellar movement, while the “U”shaped buttress limits inferior movement. • Circular buttresses are designed to stabilize the patella in multidirectional ranges of motion. • Many designs are available with an open popliteal space. • Some designs have proximal and distal straps with Velcro closures to anchor the brace to the thigh and lower leg. ➧ Position of the individual: Sitting on a taping table or bench with the leg extended off the edge, or in a
chair, with the knee in approximately 45°of flexion. ➧ Preparation: Apply fixed buttress sleeves directly to the skin; no anchors are required. ➧ Application:
STEP 1: Place the larger end of the sleeve over the foot and pull in a proximal direction. Position the cut-out over the patella and the buttress against the patella. Following the manufacturer’s instructions, pull the straps tight and secure to the sleeve with Velcro (Fig. 6–18).
Figure 6-18
Bracing Techniques
189
Adjustable Buttress ➧ Design:
• These designs allow adjustment of the buttress that is incorporated into the sleeve and/or adjustment of various straps to provide additional support to the patella (Fig. 6–19). • The sleeves are manufactured with an open patella front; some sleeves also have an open popliteal space. • Many adjustable designs contain a “C,” “H,” “J,” “U,” or circular buttress that one can reposition and/or trim to achieve the desired compression and support. • Some designs use various straps with Velcro attachments incorporated into the sleeve to limit excessive patellar range of motion. • Several other sleeves are manufactured with a fixed buttress and adjustable straps. • Most strap designs are attached on the lateral aspect of the sleeve. The straps are normally pulled in a medial direction to limit lateral movement of the patella. • Some adjustable designs use both a buttress incorporated into the sleeve and an external buttress to limit excessive patellar range of motion. • Another design uses an external buttress plate attached to a tension hinge to adjust support to the patella throughout knee range of motion. ➧ Position of the individual: Sitting on a taping table or bench with the leg extended off the edge, or in a
chair, with the knee in approximately 45°of flexion. ➧ Preparation: Apply adjustable buttress sleeves directly to the skin; no anchors are required.
The manufacturer includes specific instructions for fitting and application. For proper fit and support, follow the step-by-step procedures. The following application guidelines apply to most sleeves. ➧ Application:
STEP 1: To apply, pull the sleeve over the foot and onto the knee. Adjust the cut-out and buttress over and around the patella (Fig. 6–19A).
AA
STEP 2: Applying straps will depend on the specific brace design. Generally, pull these straps tightly in a medial direction over the thigh and lower leg and anchor on the medial or lateral sleeve with Velcro (Fig. 6–19B).
BB
Figure 6-19
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STEP 3: Position the external buttresses just next to the lateral patella and pull the straps across the superior and inferior patella; anchor on the medial or lateral sleeve (Fig. 6–19C).
. . . I F / T H E N . . . IF an
athlete requires support of the patella in the treatment of PFSS or patellar subluxation, THEN use a neoprene sleeve with buttress brace; although a neoprene sleeve does provide support, a fixed or adjustable buttress brace provides greater support and stabilization of the patella and surrounding soft tissues, lessening excessive movement.
C C Figure 6-19
continued
R ES E A R C H B R I E F Neoprene sleeves with buttresses are designed to influence patellar tracking in the trochlear groove and lessen friction and pain in the treatment of many anterior knee injuries and conditions. 17,104 Research to support the use of these braces is lacking in the literature, which perhaps can be attributed to the plethora of causes of anterior knee pain. 74 Investigations conducted with the brace designs have produced conflicting results. Some researchers demonstrated a reduction in pain and improvement in function78,102 and a reduction in the occurrence of
P a t e l l a r Te n d o n S t r a p
anterior knee pain11 with the use of buttress and strap sleeves. Other investigators have shown that these designs did not reduce pain levels. 39,71 Many researchers have suggested that neoprene sleeves with buttresses and straps compress soft tissue and limit patellar movement,80 reduce loads and increase proprioceptive feedback,11 apply a sustained force, 44,80 and should be used within a comprehensive therapeutic exercise program.17 Based on the available findings, further research is warranted to determine the beneficial effects of neoprene sleeves with buttresses and straps.
Figure 6–20
➧ Purpose: Several patellar tendon strap brace designs exist to lessen tension on the tendon at the inferior
pole of the patella and/or at the tibial tubercle, to treat patellar tendinitis, OSD, PFSS, and chondromalacia (Fig. 6–20).
DETAI LS
Use the straps with athletic, work, or casual activities. Patellar tendon straps may be used in combination with neoprene sleeves to provide compression and support.
➧ Design:
• The straps are available off-the-shelf in universal styles and predetermined sizes that correspond to inferior knee circumference measurements. Some designs are available in universal sizes. • The straps are constructed of neoprene or foam composite materials with Velcro closures. • Most designs contain a semi-tubular or tubular foam, foam/air cell, or padded plastic buttress incorporated into the strap.
Bracing Techniques
191
➧ Position of the individual: Sitting on a taping table or bench with the leg extended off the edge, or in a
chair, with the knee in approximately 45°of flexion. ➧ Preparation: Apply patellar tendon straps directly to the skin; no anchors are required. ➧ Application:
STEP 1: To apply, place the semi-tubular/tubular buttress over the patellar tendon, between the inferior pole of the patella and tibial tubercle (Fig. 6–20A).
AA
STEP 2: Pull the ends snugly together and anchor on the posterior knee with the Velcro closures (Fig. 6–20B). Allow the individual to perform a previously painful activity. Readjust the strap if necessary.
BB
Figure 6-20
Orthotics ➧ Purpose: Orthotics provide support, absorb shock, and correct structural abnormalities when treating
knee injuries and conditions. • Use soft orthotic designs (see Fig. 3–16) to absorb shock and lessen stress on the patellar tendon to treat OSD and SLJ. The soft designs can also be used to absorb shock when preventing and treating stress fractures of the tibial tubercle, tibial plateau, and femoral condyles. Heel cups and full-length neoprene, silicone, and viscoelastic polymer insoles are available in off-the-shelf designs. • Use semirigid (see Fig. 3–17) and rigid (see Fig. 3–18) orthotics to provide support and correct structural abnormalities like excessive foot pronation, leg-length discrepancy, genu varus or valgum, or external tibial torsion when treating iliotibial band friction syndrome, chondromalacia, PFSS, and pes anserinus bursitis and tendinitis. The designs can be purchased off-the-shelf or custom-made.
Critical Thinking Question 5 The first mate on a charter fishing boat sustains a torn ACL of the left knee. After imaging studies and a clinical examination by a surgeon, the surgeon schedules ACL reconstruction. The surgeon schedules the procedure 2 weeks post-injury to allow for a reduction in effusion and an increase in range of motion. The first mate will receive daily therapy at a local outpatient orthopedic clinic and can ambulate as tolerated.
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Question: What wrapping and bracing techniques can you use during the 2-week period?
K n e e
Taping Techniques 362 b m u h Figure 11–12 T d ➧ Purpose: A semirigid cast provides maximum support and limits MCP joint and wrist range of motion n a (Fig. 11–12). This cast should be applied only by qualified health-care professionals. Use the thumb spica , s cast when treating sprains and postdislocation and postfracture injuries upon a return to activity. The cast r e may be applied and reused, if removed carefully following athletic or work activities. g n i ➧ Materials: F • 2 inch or 3 inch semirigid cast tape, gloves, water, self-adherent wrap, 1 ⁄ 8 inch foam or felt, 2 inch elastic , d tape, taping scissors n a Option: H
Th u m b S p i c a S e m i r i g i d C a s t
• Thermoplastic material, a heating source
➧ Position of the individual: Sitting on a taping table or bench with the hand, thumb, and wrist in the posi-
tion to be immobilized (as indicated by a physician) and the fingers in abduction. ➧ Preparation: Pad bony prominences with 1 ⁄ 8 inch foam or felt to lessen the occurrence of irritation. ➧ Application:
STEP 1: Apply two to three layers of selfadherent wrap to the hand, thumb, and wrist with mild to moderate roll tension with the basic thumb spica and figure-of-eight patterns (see Figs. 10–3 and 11–12A).
AA
STEP 2: Using 2 inch or 3 inch semirigid cast tape, anchor on the medial dorsal surface of the wrist and proceed around the wrist and thumb with the basic thumb spica pattern with moderate roll tension (Fig. 11–12B).
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STEP 3: Depending on the individual’s size, the cast tape may need to be cut partially when encircling the thumb (Fig. 11–12C).
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Figure 11-12
Taping Techniques
STEP 4: Alternate the basic thumb spica pattern with figures-of-eight involving the hand and wrist with moderate roll tension, overlapping the tape by 1 ⁄ 3 to 1 ⁄ 2 of its width (Fig. 11–12D). The cast tape should remain proximal to the MCP joints of fingers two through five, and proximal to the IP joint of the thumb. Option: Incorporate thermoplastic material over the MCP joint for additional support (Figs. 11–12E and 11–21F).
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DD
FF
STEP 5: Finish the tape on the dorsal wrist and smooth and mold the cast with the hands (see Fig. 11–12G). STEP 6: Prior to athletic practices and competitions, cover the semirigid cast with high-density, closed-cell foam of at least 1 ⁄ 2 inch thickness (Figs. 11–21A and 11–21B). G G STEP 7: Following athletic or work activities, remove the cast with taping scissors along the ulnar aspect of the cast (Fig. 11–12H). Allow the inside of the cast to dry overnight by removing the self-adherent wrap and placing the cast in a well-ventilated area . HH
STEP 8: When reusing, apply two to three layers of self-adherent wrap to the hand, thumb, and wrist with the basic thumb spica and figure-ofeight patterns with moderate roll tension. Replace the cast on the hand, thumb, and wrist, and anchor with 2 inch elastic tape or self-adherent wrap in a circular pattern with moderate roll tension (Fig. 11–12I). I
I
Figure 1 1-12
continued
363
H a n d , F i n g e r s , a n d T h u m b
Wrapping Techniques 364 b m Helpful Hint: Place a tongue depressor inside the cast to spread the edges u h apart to ensure drying. T d n a , s r e g n i F ➧ Purpose: The figure-of-eight tape technique is used to anchor padding when preventing and treating hand , d injuries and conditions. n a • Use the figure-of-eight tape technique (see Fig. 10–3) to attach protective padding when preventing and H
Fi g u r e -o f -Ei g h t Ta p e
treating contusions.
Critical Thinking Question 2 During the middle of the season, an offensive tackle on the football team sustains a third degree right thumb ulnar collateral ligament sprain during practice. After surgery, he is immobilized in a rigid thumb spica cast for 3 weeks. Rehabilitation begins, after which he and the surgeon begin to discuss his return to activity. The surgeon allows a return to activity based on the following guidelines: Postop weeks 3 to 6: Return to practice and competition at postop week 4 with maximum support, splinting of the right thumb during nonathletic activities. Postop weeks 6 to 8: Continue athletic participation with moderate support, discontinue nonathletic activity splinting.
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Question: What techniques can be used in this situation?
W r a p p i n g Te c h n i q u e s Wrapping techniques provide compression and support when treating hand, finger, and thumb injuries and conditions. Elastic wraps, tapes, and sleeves, self-adherent wrap, and conforming gauze are used to control swelling following injury. Wraps may be used to anchor protective padding following soft tissue and bone injuries.
C o m p r e s s i o n Wr a p
Figure 11–13
➧ Purpose: Compression wraps for the hand, fingers, and thumb reduce mild, moderate, or severe swelling
and inflammation by applying mechanical pressure 9 when treating contusions, sprains, dislocations, and tendon ruptures (Fig. 11–13). ➧ Materials:
• 2 inch, 3 inch, or 4 inch width by 5 yard length elastic wrap, metal clips, 1 1 ⁄ 2 inch non-elastic or 2 inch elastic tape, 1 ⁄ 8 inch or 1 ⁄ 4 inch foam or felt, taping scissors • 1 inch elastic tape or self-adherent wrap for the fingers or thumb Options: • Self-adherent wrap • 1 ⁄ 4 inch or 1 ⁄ 2 inch open-cell foam ➧ Position of the individual: Sitting on a taping table or bench with the wrist and hand in a pain-free
position and the fingers in abduction. ➧ Preparation: Place 1 ⁄ 8 inch or 1 ⁄ 4 inch foam or felt over the inflamed area directly on the skin.
Wrapping Techniques
365
➧ Application:
STEP 1: For the hand, anchor the elastic wrap on the dorsal hand in a circular pattern just distal to the MCP joints of fingers two through five and apply the hand compression wrap technique (see Figs. 10–11 and 11–13A). Options: Self-adherent wrap may be used if an elastic wrap is not available. Place a 1 ⁄ 4 inch or 1 ⁄ 2 inch open-cell foam pad over the dorsal hand for additional compression to assist in venous return (see Fig. 11–22A). Apply the pad directly on the skin and cover with the hand compression wrap. AA
STEP 2: For the fingers or thumb, apply 1 inch elastic tape or self-adherent wrap in a distal-toproximal circular pattern over the finger or thumb (Fig. 11–13B). Apply pressure greatest at the distal end and less toward the proximal end. The tip of the finger or thumb should remain exposed to monitor circulation. No additional anchor is required. BB
Figure 1 1-13
Fi n g e r S l e e v e s
Figure 11–14
➧ Purpose: Use finger sleeves to provide mild to moderate support and compression to the PIP joint to
reduce mild, moderate, or severe swelling when treating sprains (Fig. 11–14). The benefit of this technique is that the individual can apply the sleeve without assistance following application instruction. ➧ Design:
• The sleeves are available off-the-shelf in predetermined sizes based on finger width measurements. • Most sleeves are constructed of nylon and elastic materials in a single or double finger design. • The design of the sleeve allows for normal range of motion at the DIP joint. ➧ Materials:
• Off-the-shelf single or double finger sleeve ➧ Position of the individual: Sitting on a taping table or bench with the hand, fingers, and thumb in a pain-
free position. ➧ Preparation: Apply the finger sleeve directly to the skin. ➧ Application:
STEP 1: To apply, pull the sleeve onto the finger(s) in a proximal direction (Fig. 11–14A). No anchors are necessary; the sleeves are washable and reusable.
AA
Figure 1 1-14
H a n d , F i n g e r s , a n d T h u m b
